481-69.28 Food Service – Meals & Nutritional Requirements

The rules in 481-69.28 include the majority of the requirements related to food service. Since this is a longer chapter, we will cover the first few rules in this article.

Assisted living programs are required to provide or arrange with another provider to deliver at least one hot meal per day. Programs are able to offer more than one meal, but the minimum requirement is at least one to be licensed as an assisted living. If meals and snacks are offered but not prepared on site, they must be obtained from an entity that meets the standards of state and local health laws and ordinances concerning the preparation and serving of food. Most programs meet this requirement by being licensed as a restaurant or food service establishment. These inspections are contracted out and not completed by DIAL surveyors.

Menus must be planned to provide percentages of the daily recommended dietary allowances based on the number of meals provided by the program. The minimum must meet at least 33 1/3% based on the requirement to provide at least one meal daily. If the program provides two meals per day, the program must plan for providing at least 66 2/3% of the nutritional requirements and 100% for three meals.

Therapeutic diets may be provided by the program. If they are provided, they must be ordered by the physician, physician assistant or advanced registered nurse practitioner, a qualified dietitian, or other qualified medical provider. A therapeutic diet is defined as providing food, fluids, or nutrients by oral, enteral, or parenteral routes and used in the treatment of a disease or clinical condition to modify, eliminate, decrease or increase specific macro- or micronutrients, or to provide a mechanically altered diet when indicated. If therapeutic diets are provided, a licensed dietitian must be responsible for writing and approving the therapeutic menu and reviewing the procedures for food preparation and service. While it isn’t indicated in these specific rules, the staff must be competent in therapeutic diets if they are offered.

While food service regulations are a common regulatory insufficiency, these specific rules are not commonly cited.